Chapter 6: Relationship Development and Therapeutic Communication
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____1.What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship
with a client?
1.Clarify personal attitudes, values, and beliefs.
2.Obtain thorough assessment data.
3.Determine the client’s length of stay.
4.Establish personal goals for the interaction.
____2.If a client demonstrates transference toward a nurse, how should the nurse respond?
1.Promote safety and immediately terminate the relationship with the client.
2.Encourage the client to ignore these thoughts and feelings.
3.Immediately reassign the client to another staff member.
4.Help the client to clarify the meaning of the relationship, based on the present
situation.
____3.What should be the priority nursing action during the orientation (introductory) phase of the nurse-
client relationship?
1.Acknowledge the client’s actions, and generate alternative behaviors.
2.Establish rapport and develop treatment goals.
3.Attempt to find alternative placement.
4.Explore how thoughts and feelings about this client may adversely impact nursing
care.
____4. Which client action should a nurse expect during the working phase of the nurse-client relationship?
1.The client gains insight and incorporates alternative behaviors.
2.The client establishes rapport with the nurse and mutually develops treatment
goals.
3.The client explores feelings related to reentering the community.
4.The client explores personal strengths and weaknesses that impact behavioral
choices.
____5.Which client statement should a nurse identify as a typical response to stress most often experienced
in the working phase of the nurse-client relationship?
1.“I can’t bear the thought of leaving here and failing.”
2. “I might have a hard time working with you, because you remind me of my
mother.”
3.“I really don’t want to talk any more about my childhood abuse.”
4.“I’m not sure that I can count on you to protect my confidentiality.”
____6.A mother who is notified that her child was killed in a tragic car accident states, “I can’t bear to go
on with my life.” Which nursing statement conveys empathy?
1.“This situation is very sad, but time is a great healer.”
2.“You are sad, but you must be strong for your other children.”
3.“Once you cry it all out, things will seem so much better.”
Copyright © 2017 F. A. Davis Company
Orientation:
- In the beginning of the therapeutic relationship, the nurse and client are strangers to each other, yet each individual has preconceptions of what to expect – based on previous relationships, experiences, attitudes and beliefs
- The parameters of the relationship are established (e.g., place of meeting, length, frequency, role or service offered, confidentiality, duration of relationship)
- The client and nurse begin to learn to trust and know each other as partners in the relationship
- Trust, respect, honesty and effective communication are key principles in establishing a relationship
Working Phase:
- The working or middle phase of the relationship is where nursing interventions frequently take place
- Problems and issues are identified and plans to address these are put into action. Positive changes may alternate with resistance and/or lack of change
- It is important for the nurse to validate thoughts, feelings and behaviours
- The nurse assists the client to explore thoughts (e.g. views of self, others, environment, and problem solving), feelings (e.g. grief, anger, mistrust, sadness), and behaviours (e.g. promiscuity, aggression, withdrawal, hyperactivity)
- The content to be explored is chosen by the client although the nurse facilitates the process
- The nurse continues his/her assessment throughout all phases of the relationship
- New problems and needs may emerge as the nurse-client relationship develops and as earlier identified issues are addressed
- The nurse advocates for the client to ensure that the client’s perspectives and priorities are reflected in the plan of care
Resolution Phase:
- The resolution or ending phase is the final stage of the nurse-client relationship
- After the client’s problems or issues are addressed, the relationship needs to be completed before it can be terminated
- The ending of the nurse-client relationship is based on mutual understanding and a celebration of goals that have been met
- Both the nurse and the client experience growth
- Termination may be met with ambivalence
- The nurse and the client must recognize that loss may accompany the ending of a relationship
- Both should share feelings related to the ending of the therapeutic relationship
- Validating plans for the future may be a useful strategy
- Increased autonomy of both the client and the nurse is observed in this phase